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Dutch organization is producing tapering kits

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Altostrata   
Altostrata

This is a project of the Netherlands Cinderella Therapeutic Foundation www.cinderella-tx.org

 

The "strips" are packages of tablets in customized dosages.

Press release from http://www.cinderella-tx.org/k/en/n30768/cms/news/1625/Tapering-strips-for-paroxetine-shortly-available.html
Tapering strips for paroxetine shortly available

Sunday 20 October 2013 15:09
 

Twenty two prominent Dutch psychiatrists recommend the use of specially designed tapering medication for the cessation of treatment with paroxetine and venlafaxine. In the Dutch professional journal Tijdschrift voor Psychiatrie P. Groot et al.*) explain why the tapering of these antidepressants should be much more gradual than is currently possible with the registered commercial preparations.

 

At present, many patients suffer from discontinuation symptoms upon stopping the treatment. Apart from the inconvenience, some patients take resort in resuming the treatment to get rid of the symptoms. The problem is that the lowest dosages on the market are much too high for use in a safe tapering regimen.

 

There is abundant evidence from the medical literature that the incidence and the severity of discontinuation symptoms decreases when the daily doses are lowered by very small decrements over a period of several weeks, especially in the final stages of tapering. 

 

In addition, the risk of recurrence of the depression is lower.

 

With the assistance of many experts, Cinderella has succeeded in getting consensus on a tapering schedule for paroxetine that meets these requirements and in having the appropriate formulations manufactured by Paul Harder, pharmacist in Bavel near Breda.

 

Two different tapering strips will be made available:

1. Tapering strip PRXT-20-28 to lower the daily dose of paroxetine from 20 mg over 28 days to zero.

2. Tapering strip PRXT-10-21 to lower the daily dose of paroxetine from 10 mg over 21 days to zero.

 

It is expected that the strips will ready for delivery in December. A prescription from the patients’ physician is required. Instructions how to order will be published by the end of November on this site. www.cinderella-tx.org/tapering.

 

Cinderella will proceed with the development of similar tapering strips for Venlafaxine and other drugs.

 
Tijdschr Psychiatr. 2013;55(10):789-794.
[Taperingstrips for paroxetine and venlafaxine.]
[Article in Dutch]
Groot PC. E-mail
 
Abstract and free full text [in Dutch] at http://www.ncbi.nlm.nih.gov/pubmed/24194351 English translation at http://www.cinderella-tx.org/k/en/n30768/cms/news/1625/Tapering-strips-for-paroxetine-shortly-available.html
 
BACKGROUND:

Tapering strips can be used for the gradual reduction of the dose of certain types of drugs such as antidepressants and benzodiazepines. The strips contain a slightly lower dose on each consecutive day. This prevents the withdrawal symptoms still experienced by too many patients and lowers the risk of relapse.
 
AIM:

To make tapering strips of antidepressant drugs available for patients in need of a tapering-off procedure.
 
METHOD:

The Consensusgroup Tapering studied the literature and consulted with experts to find out whether the plan to make tapering strips of paroxetine and venlafaxine available for patients is feasible.
 
RESULTS:

The Cinderella Therapeutic Foundation (www.cinderella-tx.org), a not-for-profit organisation which aims to give patients access to orphan drugs and treatments, wants to make tapering strips of paroxetine and venlafaxine available since these are the two antidepressants that cause the most problems. The process of producing, packaging and checking the tapering doses is ISO-certified; each strip is provided with a bar-code and can be followed and traced. Therefore the strips will conform to current safety regulations. In view of the large number of patients taking paroxetine and venlafaxine there is likely to be a considerable demand for tapering strips.
 
CONCLUSION:

From a financial, marketing and practical point of view, the introduction of tapering strips is feasable. Patients will derive considerable benefits. The paroxetine strips will be produced first and are expected to be available from December 2013.

 

 

 

From the full text, the Netherlands psychiatrists in the Consensusgroup Tapering are:

Namens de Consensusgroep Tapering, waarvan behalve de auteur deel uitmaken (in alfabetische volgorde): Baer Arts, psychiater,  Maastricht  u m c ;  Ton  van  Balkom,  psychiater  en  hoogleraar Evidence-based Psychiatrie, afd. Psychiatrie en emgo Instituut, v u mc  en  g g z  inGeest,  Amsterdam;  Aartjan  Beekman,  hoogleraar Psychiatrie, dienst onderzoek ggz inGeest/afd. Psychiatrie, Vumc, Amsterdam; Marc Blom, psychiater, directeur zorg en bestuurder, PsyQ; TomBirkenhäger, psychiater,ErasmusmcRotterdam; BertM. van Hemert, hoogleraar Psychiatrie, lumc, Leiden; Witte J. Hoogendijk, hoogleraar Psychiatrie, Erasmus mc Rotterdam; Jan van Ingen Schenau, arts, samensteller Silhouet literatuurservice angst en depressie, 1e Exloërmond; René S. Kahn, hoogleraar Psychiatrie, umc Utrecht; Ralph Kupka, hoogleraar Bipolaire stoornissen, vumc, en psychiater, ggz inGeest en Altrecht ggz; Roos C. van der Mast, hoogleraar Ouderenpsychiatrie/opleider Psychiatrie, lumc, Leiden; Willem A. Nolen, emeritus hoogleraar Psychiatrie, in het bijzonder Emotionele  Stoornissen,  afd.  Psychiatrie,  u m c  Groningen;  Jim van Os,  hoogleraar  Psychiatrische  epidemiologie,  Maastricht  u m c ; Frenk Peeters, psychiater, Maastricht umc en Riagg, Maastricht; Eric Ruhé, psychiater-epidemioloog, afd. Stemmings- en Angststoornis- sen,  u m c  Groningen  en  Zorgprogramma  Stemmingsstoornissen, afd. Psychiatrie, Amc Amsterdam; Aart Schene, hoogleraar Psychia- trie,  Zorgprogramma  Stemmingsstoornissen,  afd.  Psychiatrie,  Am c , Universiteit van Amsterdam; Floor Scheepers, hoofd afd. Psychiatrie, umc Utrecht; Robert Schoevers, hoogleraar Psychiatrie en afdelings- hoofd,umcGroningen; Anne Speckens, hoogleraarPsychiatrie,umc St Radboud, Nijmegen; Jan Spijker, hoogleraar Chronische depressie, umcStRadboud,Nijmegen,psychiater, ProPersona,Nijmegenen Trimbos-instituut, Utrecht; Jan Swinkels, psychiater en hoogleraar Richtlijnontwikkeling  in  de  gezondheidszorg,  Am c ,  Amsterdam; Ton Vergouwen, psychiater en opleider psychiatrie, Sint Lucas Andreas Ziekenhuis, Amsterdam; Frank C. Verhulst, hoogleraar Kinder-enJeugdpsychiatrie,Erasmusmc-Sophia,afd. Kinder-enJeugd- psychiatrie/psychologie, Rotterdam.

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Altostrata   
Altostrata

From the English translation of Groot, 2013 at http://www.cinderella-tx.org/k/en/n30768/cms/news/1625/Tapering-strips-for-paroxetine-shortly-available.html
 
Coming off antidepressants is in practice often harder than expected and is problematic in more than half of all cases (Van Geffen et al, 2005). This is particularly the case for antidepressants with a short half-life such as paroxetine and venlafaxine. With- drawal of these drugs is often accompanied by the occurrence of discontinuation symptoms, sometimes very serious (see below), especially after prolonged use at higher doses.
 
Why gradual dose reduction is important
The main cause of these problems is that withdrawal is too rapid, which does not give the body sufficient time to adjust to the lower doses. This is why official guidelines and package leaflets rightly state that people wishing to stop taking antidepres- sants should do so gradually and under the guidance of their doctor (Van Weel-Baumgarten et al. 2012).
 
What exactly is meant by ‘gradual’ is not mentioned however and guidelines for tapering of antidepres- sants are lacking (Groot & van Ingen Schenau 2013).
Following recovery from depression, relapse is known to occur more often and earlier if withdrawal is rapid rather than gradual (Baldessarini et al. 2010). The magnitude of this effect is unclear. Prospective studies in the form of randomised clinical trials – which might provide an answer – have never been done and appear to be hardly feasible.
....
Problem of unpredictability
Doctors face two problems when they help pa- tients to taper their antidepressants. The first problem is one of unpredictability: they do not (and cannot) know which type of tapering schedule will suit which patient. While some patients manage with current schedules, it is not clear to what degree these patients suffer from discontinuation symptoms and whether their doctor gets to hear this. With other patients, current schedules fail despite rigid adherence because of the occurrence of discontinuation symptoms.
 
Most symptoms appear to occur during the final phase of tapering. For many patients, the step from 5 mg paroxetine to nothing and from 37.5 mg venla- faxine to nothing appears to be too big. In order to understand why this happens, we must consider the difference between the biochemical effects of anti- depressants and their clinical effects, upon which the current standard dosages are based. SSRIs inhibit the reuptake of serotonin by blocking the serotonin receptor, a process that requires only very low con- centrations. At such low concentrations, occupancy of serotonin receptors increases exponentially as SSRI concentrations increase (Meyer at al. 2004). Vice versa, this means that a small decrease in the daily dose leads to a very strong decrease in the occupancy of serotonin receptors, particularly if the daily dose is already below the lowest standard dose. This may explain why it is at these low doses that discontinuation symptoms are most frequently seen.
 
Practical problem
The second problem faced by doctors helping their patients to taper is that currently there are only limited practical options available. For paroxetine, the patient can split a pill into two or into four parts, or have the drug prescribed in liquid form, which is not practical for all patients. Venlafaxine is only available in capsules. This is why, despite a doctor’s best intentions, some patients are wrongly advised to take a capsule every other day, leading to discontinu- ation symptoms every other day. In practice, some venlafaxine users solve this problem by opening the capsules, counting the grains within, and taking a few grains less each day. Although it is considered unde- sirable for patients to fiddle with their medication, this does allow patients to successfully taper their antidepressants at their own pace, sometimes over a period of months.
 
A final option is to first replace the antidepres- sant in question with fluoxetine, which has a very long half-life and therefore disappears from the body very gradually, resulting in fewer discontinuation symptoms or none at all. However, this makes dis- continuation more complicated for both patients and doctors. Actually, patients are being let down because pharmaceutical companies are failing to supply the formulations needed to properly taper these drugs.
....
TAPERING STRIPS: TECHNICALLY FEASIBLE
....
The pills to be taken by an individual patient are packaged by means of a fully automated process into a strip consisting of seperate compartments, each containing the medications for a specified time-point. The entire process is ISO- certified – after packaging, the pills or capsules are checked using a camera and each separate strip is provided with a barcode so that it can be followed and traced. Meeting the current safety requirements for medications will therefore not be a problem. Thanks to the automated nature of this process, it will also be possible to fill prescriptions for tailored tapering schedules. This will serve and reassure those patients who are still experiencing problems, even when they taper their medication very slowly.
....

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Jemima   
Jemima

At last, someone has figured out what to do. This may not be perfect, but it looks like a really good start to me.

 

Now, if doctors could be convinced to not prescribe this worthless, dangerous stuff in the first place....

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Barbarannamated   
Barbarannamated

I agree that there's good information and intention in this project.

 

I'm not sure if I'm reading this correctly. Are these considered full doses of paroxetine to be tapered in 3 or 4 weeks?

 

"Two different tapering strips will be made available:

1. Tapering strip PRXT-20-28 to lower the daily dose of paroxetine from 20 mg over 28 days to zero.

2. Tapering strip PRXT-10-21 to lower the daily dose of paroxetine from 10 mg over 21 days to zero."

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Altostrata   
Altostrata

As I read it, the packets will contain tablets of decreasing dosages.

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Jemima   
Jemima

I agree that there's good information and intention in this project.I'm not sure if I'm reading this correctly. Are these considered full doses of paroxetine to be tapered in 3 or 4 weeks?"Two different tapering strips will be made available:1. Tapering strip PRXT-20-28 to lower the daily dose of paroxetine from 20 mg over 28 days to zero.2. Tapering strip PRXT-10-21 to lower the daily dose of paroxetine from 10 mg over 21 days to zero."

 

Whoops.  I didn't catch that at first glance.  That does seem a lot too fast.

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Barbarannamated   
Barbarannamated

This sounds very hopeful:

 

"Thanks to the automated nature of this process, it will also be possible to fill prescriptions for tailored tapering schedules. This will serve and reassure those patients who are still experiencing problems, even when they taper their medication very slowly."

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areyouthere   
areyouthere

I do not understand this passage. Can someone further explain? :
 
"Most symptoms appear to occur during the final phase of tapering. For many patients, the step from 5 mg paroxetine to nothing and from 37.5 mg venla- faxine to nothing appears to be too big. In order to understand why this happens, we must consider the difference between the biochemical effects of anti- depressants and their clinical effects, upon which the current standard dosages are based. SSRIs inhibit the reuptake of serotonin by blocking the serotonin receptor, a process that requires only very low con- centrations. At such low concentrations, occupancy of serotonin receptors increases exponentially as SSRI concentrations increase (Meyer at al. 2004). Vice versa, this means that a small decrease in the daily dose leads to a very strong decrease in the occupancy of serotonin receptors, particularly if the daily dose is already below the lowest standard dose. This may explain why it is at these low doses that discontinuation symptoms are most frequently seen." 
 
I would like to understand more thoroughly why it is at the lowest doses that it becomes more difficult. If anyone can help explain the above using examples or analogies to simplify I would appreciate it.
RU

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Rhiannon   
Rhiannon

I can't say I know the pharmacokinetics, but I think the key is in the word "exponentially." So that twice the dose does not produce 2 times the effect, it produces (effect to the power of 2). And a reduction by half doesn't produce half the effect, it produces the square root of the effect.  (For example, if the effect at a certain dose was at a level of 16 and you cut that dosage in half, if it was linear the effect would go down to 8, but if it's exponential the effect goes down to 4, which is the square root of 16).

 

When you are at higher doses there are more molecules available to take up the slack, so you don't get that exponential effect.

 

That's my speculation of roughly what that means.

 

Our version of the 10% reduction--10% of your current dose, not 10% of your original dose--is logarithmic (which follows the same nonlinear pattern as exponential). Maybe that's why it works. Personally I think there are many other factors involved in withdrawal--especially the endocrine effects, which are rarely if ever discussed in works like this--but I do think this "exponential/logarithmic versus linear" thing is very important.

 

I'm impressed with the amount of insight this author has into the problems of AD tapering and reduction. Not as much as our Alto does, true, but for a doctor he's not too stupid at all.

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areyouthere   
areyouthere

" for a doctor he's not too stupid at all."

ha ! That's a GOOD one!! Thanks for the explanation Rhi. Just what the "doctor" ordered!!  ;)

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Altostrata   
Altostrata

Pshah.

 

It seems this panel did some serious thinking about problems in withdrawal.

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Claudius   
Claudius

I have read this before and I have been in contact with one of the authors, Peter Groot. I read his article about tapering in a well known Dutch paper and was very surprised to read a few of my own posts in his article, which he had cited from the website of "Tros Radar", a well known Dutch consumers TV program.  

 

I wrote him a mail early 2013 and he mailed me back and was very kind. He even stated that I could have contributed to this initiative. Indeed I am not fully confident about the tapering schedule of tapering off paroxetine in one month and I wrote him last month to tell him that. He has not reacted to that mail, but indeed is is a good start, albeit 20 years too late.    

 

Maybe you are interested in the mail he sent me, as well as my original email to him, I will post a Google translation below:        

 

Dear Mr. van G, dear Klaas ,

 

Thanks for your email. Nice to hear from one of those we have listed . Citations in our report something Those stories on the Internet make it very clear what problems patients themselves have to make , and that they therefore sometimes found the medical profession itself better solutions.  

 

It must be before a change takes place as long as I try to see as a fact- of-life as possible. Itself Myself excited about ( and I can very well ) leads me in the pratice only that I ruined my mood . Therefore , I'm trying to consciously do as much as possible in every case rather to the future. That I can not always , but it helps me and asked me at least be able to write as I have written bottlenecks note : focus on change and improvement . I experience more satisfying if I can contribute to change than when I myself - how justified it might be - for example winding lawsuits against pharmaceutical companies . I understand the anger and indignation , but also see that these lawsuits is a whole industry holding back on expensive lawyers to work. There is a cynical man easily and that is for someone with a depressive impact not useful emotion . What is more, it is often not achieved much . Because even if a pharmacist must ultimately pay a fine, what does that mean ? Patients would be better served with a generous confession and sincere apologies than with x - amount after so many years of litigation . That amount they might receive , but those excuses , I do not expect much . You write at the end of your e-mail ' Your research will hopefully change that here . " I hope with you that that will happen . A first step would be actually made ​​available to ' outfitting packages " can be. Paroxetine There is a concrete initiative in this direction where i can say. Much more at this time For you, that is unfortunately too late, but maybe it's a ( poor ) consolation for you to know you are there to have contributed . Indirectly with your comments on the Internet   with warm regards ,   Peter Groot    

 

From: Klaas van G [ mailto : klaasg@xxxxxxx ]

Sent : Saturday, January 5, 2013 12:52

To: x.x.groot @ xxxxx ; info@xxxxxxxx

Cc : redactie@xxxxxxxxx

Subject : Article Finishing antidepressants and experience Seroxat / Paroxetine  

to: Dr . And Dr. Peter Groot . Jan van Ingen Schenau

 

Utrecht , January 5, 2013

 

Dear Sirs Groot and van Ingen Schenau ,

 

I recently read the article " Finishing antidepressants could be much better " in Medical Help from December 14, 2012 , I received from my sister who works at the KNMG . The article immediately aroused my interest and on the website of Medical Help , I have also extensive article " Antidepressants better taper , Plea for a directive : discontinuation of antidepressants , a bottleneck " read.

 

First of all I would like to compliment you on the detailed and clear analysis of the problems especially the SSRI and SNRI antdepressiva which have hardly been exposed and even to the absurd denied within the medical and pharmaceutical world . And then I was surprised to read this article which I have posted. As " expert by experience " in the course of the past 3 years on various forums some of my own contributions back These are the following amounts which of my hand : 5 . .... GPs and psychiatrists have no idea majority the terrible withdrawal symptoms these resources and the need to very , very slowly winding down .

 

I would be a kill for it if I could turn back but unfortunately I This site only when I found one and a half years in my cold turkey was and it was too late to build according to the only correct schedule. 11. .... However, the scheme as described above is still not completely times correctly . The highly skilled website is Paxilxxxxx.org leading in terms of knowledge in this area . The site focuses primarily on withdrawal from Paxil ( Paroxetine / Seroxat ) , but also many Members who want to quit venlafaxine or any of the other crap SSRI drugs. The site recommends a dose reduction of 5-10 % by 3-6 weeks. So no half rings ! And indeed means This count granules or pills filing and weigh .

 

It is encouraging to read that finally doctors / researchers who take note of the reports of ( ex ) users of these resources is often no other platform than internet forums to share their experiences and support in the often excruciating process together of reducing and stopping . For me, stopping Paxil ( Paroxetine / Paxil ) was absolutely the most horrific experience of my life and it was even very nearly it had been .

 

Recent experience

The last two years of my total five -year Paxil use had been a dramatic period of quit attempts followed by forced to start the absolutely intolerable withdrawal symptoms , which work and function perfectly normal daily made ​​it impossible to disappear again. Although I called the doctor and a psychiatrist visited was never explained to me about the risks of stopping this means , right then and reduction protocols hindsight I totally misinformed as said with disastrous consequences .

 

Finally I decided to quit the drug because lifelong swallow was totally unacceptable to me and I still had no idea what was waiting for me after final cessation of intake of daily 10 mg ( package insert advises even after repeated failed attempts however, a question still to be built in increments of 10 mg and because I " only" 10 mg used so this was a step, and I have therefore followed the official protocol ) . Among others I was told that the drug was " not addictive " ( which thus in my opinion very misleading pharmaceutical definition is used where addiction is completely disconnected from withdrawal symptoms , irrespective of the duration and severity ) , that withdrawal symptoms " are mild and within a few weeks on " should be the dose of 10 mg" homeopathic "and " I do not swallow " which was totally ignores the nature and severity of withdrawal symptoms , both physical , psychological and neurological and no relationship for nothing had a reason for writing , although let himself in such a way apply during the withdrawal my rather traumatic ( plague) past that I myself believed for some time that the traumatic memory , which came back as if it had happened yesterday, had made me sick because each associated with paroxetine was denied and was also said to be " out of my body was long " after so many weeks / months .

 

After the last stop , in September 2007 , I refused to start with and it has become the most hellish ride of my life . The terrible diarrhea and stomach cramps were after about twenty months the first " withdrawal symptom " that disappeared even though I do in all other respects still a living corpse felt with a range of piece by piece unbearable physical and mental symptoms including temper tantrums and endless crying for nothing , overall cognitive loss , tingling and electricity shoots through skin and heart region , eye muscle spasms , waves of nausea , headaches and electrically charged scalp to name but a few.

 

About the same time I discovered the then largest support site http://www.paxilxxxxxx.org and then finally the scales fell from my eyes. Now, five years after stopping there is much restoration but my job , I have long been lost because I was not very long able to work . Happy to work again for 50 % away from home that I get a small addition to the WIA and I hope my career in IT due time yet again to resume . At least as bad as the horrible symptoms was the wall of ignorance and denial that I was against it , both GPs , psychiatrists and occupational physicians . Even after I had found , among other reputable and independent researchers and authors of several books on the subject of many publications as Prof. David Healy , Prof. Dr. Peter Breggin and a astronomical number of reports of patients especially Seroxat ( paroxetine ) and Effexor ( venlafaxine ) was allowed to persist in this denial , they tried to get me to the pills again or gave several psychiatrists that I immediately asked " not to be available " when they heard what it was about . via email for help By now I had learned that because the damage was precisely due to the much too soon, in my case cold-turkey withdrawal that especially in the case of Paxil, also from 10 mg , a great drain on your body and mind is that this has nothing to do with waste material but rather to the abrupt stop of an agent whose chemical signals between nerve cells become total ( arguing that " it is already out of your body " is so totally disabled ) and to stimulate the for me it was too late to secure, ie to phase very slow , gradual and consistent ( the  doctors mentioned above recommend in consultation with the major online support site 5-10 % reduction per line 3-6 weeks ) and I could do nothing more than recovery wait and this could ever going to be a matter of years (the term of 4-7 years is often called ) without any possibility to speed up this process. All this time I've been in fear that my payment would be withdrawn because I was accused of " not listening to doctors , did not want to swallow my medication and did not want to deal with me," and knowing that even psychiatrists often not height and still rely on the guidelines of the drug manufacturers .

 

And while I had also discovered that Paxil manufacturer GlaxoSmithKline long and macabre history of concealment of information , " ghostwriting " and been convicted multiple times as massive fines , about 10 years ago already been two documentary series about Seroxat - scandal were broadcast on the BBC , but where apparently the manufacturer unfortunately still more lucrative to persist in denial, pay the fines and continue to go through. on the same footing In the case of Paxil now seem many doctors in the Western world to be the extreme risks of this agent still slowly penetrated and less frequently prescribe what bijkbaar response has been to bring the means now to the man for GlaxoSmithKline 's far East to still milking , including the last penny profit out clear from this publication : http://truthman30.wordpress.com/2010/12/16/seroxat-in-china/

 

Many of the problems I read back into your article and I hope this is the start will be in a situation where patients are informed honestly and assisted where necessary by safely dismantle these resources where the costs can be recovered from the manufacturers who have such juggled the definition of addictive and knowingly withheld information and manipulated so there is absolutely no question of a responsible and well- informed decision about a drug as Seroxat / Paroxetine / Paxil go swallow , nor proper guidance in phasing / stop . Unfortunately, it seems that this manufacturer has no interest to their means of an " exit strategy " to provide . And as Paxil , I still can not understand that this means at all is allowed , after all reports , lawsuits , TV reports and thousands of deceased children (who received the drug while GSK knew that this was absolutely unsafe , see in the 90s include below mentioned article) has still not been removed from the market and manufacturer GSK despite the fines it stays here and get away with the responsible criminals are still at large . See also the article on http://www.psy.nl/meer-nieuws/dossier/Artikel/misleiding-kost-farmaceut-drie-miljard-dollar/

 

I have , therefore , perhaps unnecessarily , in this mail are enclosed a copy of the petition Paxil site where thousands of victims to notify them that Paxil / Seroxat has done with them , especially during the withdrawal / withdrawal . If things are not true , and I myself had not experienced it I would perhaps also can not believe that this horror the bitter reality for hundreds of thousands of innocent people who are in a difficult period of their lives, sought help from a doctor to a "safe and not to get addictive " remedy their stress , anxiety or depression prescribed.

 

Finally, I would like to say that , now 5 years ill due to their habit , but now so does recovering , still do not have a formal diagnosis because the SSRI withdrawal syndrome still does not officially exist and is recognized only by very few physicians ( h ) . And I am also fallen to the level of benefits because of the extension of the WIA benefit a diagnosis of a medical specialist is needed now. Although money is not the only one, I find it incomprehensible that so far no doctor willing / has been able to establish that all information about Paxil, including patient reports , TV reports and the numerous lawsuits and the shameless correct diagnosis cheats manufacturer GlaxoSmithKline are included in the comparison. Not to mention a compensation for the fact that these "non - addictive wonder drug " has made inadequate and erroneous information to physicians and the deceit of the years of my life , and that of hundreds of thousands with me , to an unbearable hell manufacturer .

 

Therefore, I would also resolve to ask if you could recommend who is aware of this matter in all its facets to come . Establish a correct diagnosis to find a good doctor in the me My doctor , after an official complaint fro my side accompanied by a bulky suit publications finally tends me to believe has unfortunately mean because it falls outside the scope of general practice and psychiatry ( exceptions but I have this little could not find it ) in the Netherlands, all too often an extension of the pharmaceutical industry and has so far not been here I totally helpful.

 

I also hope that my mail still contributes to knowledge in this field and questions I am always willing to answer . Incidentally, I have been through several online support sites reach a large number of people, warned of the consequences of the withdrawal , and pointed to the need to be extremely cautious and slow to do so. Unfortunately, it's the year 2013 apparently still need people to sort this yourself via the Internet, which many never get the truth because their doctors remain confident and that would not be like that. I still get very often emails from people who hear their doctor got that you can just quit Paxil , or the most bizarre and dangerous reduction schedules apply , including phasing in a few weeks or , worse , skipping doses , and thus are at risk of coming . same hell I give these people explain the 5-10 % reduction rule and some have already let me know that I probably saved their lives ... Many have thus lost all confidence in the regular medical care . Your research will hopefully change anything here .

 

Sincerely , Klaas van G

Edited by Altostrata

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Altostrata   
Altostrata

Hi, Claudius! Thanks for letting us know about this. I have no doubt your testimony in Web posts influenced this research group.

 

Please consider sending Dr. Groot a link to our Tapering section http://tinyurl.com/42ewlrl

 

I believe the way it is organized will inform the researchers as they develop tapering packets for other drugs.

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Fenrir   
Fenrir

completely useless, 28 days to get off paroxetine is way too fast. It takes months or years

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Claudius   
Claudius

I also have some doubts about this method, it would be better to produce tablets of 1 and 2 mg with a divider slice so that every dosage with an interval of 0.5 mg can be made using the 5, 2 and 1 mg tablets.

If the tapering strips do not give the possibilty to stay on a certain dose for some time, it is indeed far from the best solution.

 

But at least a group of psychiatrist does recognize the withdrawal problems and that is more than we could dream of a few years ago...

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btdt   
btdt

I did a new search on this today as I thought it was a great step forward to have people taper and avoid cold turkeys long and horrid effects. IF it were to come to pass. I found this  but still can't tell if these pills are on the market or not?????

 

Taperingstrips for paroxetine and venlafaxine.

10:32 EDT 15th June 2014 | BioPortfolio

Summary of "Taperingstrips for paroxetine and venlafaxine."

Tapering strips can be used for the gradual reduction of the dose of certain types of drugs such as antidepressants and benzodiazepines. The strips contain a slightly lower dose on each consecutive day. This prevents the withdrawal symptoms still experienced by too many patients and lowers the risk of relapse.

Affiliation

 

Journal Details

This article was published in the following journal.

Name: Tijdschrift voor psychiatrie
ISSN: 0303-7339
Pages: 789-794

Links

 

link here

http://www.bioportfolio.com/resources/pmarticle/744176/Taperingstrips-for-paroxetine-and-venlafaxine.html

PubMed Articles[49 Associated PubMed Articles listed on BioPortfolio]

Rapid weight gain associated with edema after use of paroxetine and venlafaxine: 2 case reports.

Edema is a rarely observed adverse effect of the usage of antidepressant, with only few case reports of peripheral edema in the literature. This report included 2 patients who presented with rapid wei...

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New validated HPLC methodology for the determination of (-)-trans-paroxetine and its enantiomer in pharmaceutical formulations with use of ovomucoid chiral stationary phase.

A new chromatographic method for the enantioseparation and the determination of (-)-trans-paroxetine and (+)-trans-paroxetine has been developed with the aid of amylose ovomucoid-based chiral stationa...

Paroxetine versus other anti-depressive agents for depression.

Paroxetine is the most potent inhibitor of the reuptake of serotonin of all selective serotonin reuptake inhibitors (SSRIs) and has been studied in many randomised controlled trials (RCTs). However, t...

Acute Bilateral Parotitis Occurring during Venlafaxine Titration in an Adolescent Female with Major Depression.

Parotitis is a fairly uncommon adverse drug reaction of psychopharmacological treatment. Here, we report on an acute bilateral parotitis, which was associated with titration of venlafaxine in a 20-yea...

Clinical Trials[163 Associated Clinical Trials listed on BioPortfolio]

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The primary purpose of this study is to investigate the effectiveness of antidepressants on the treatments for non-psychotic major depressive disorder (MDD) in Korea. The study divides MDD...

Physiologic Monitoring of Antidepressant Treatment Response

Primary: to identify physiologic indicators of venlafaxine treatment response using quantitative EEG (QEEG) cordance, and to determine if cordance changes are specifically associated with...

Study Evaluating Venlafaxine Extended-Release in Depressed and Anxious Patients

To examine the efficacy and safety of venlafaxine XR in the treatment of physical and emotional symptoms in patients with an operationally-defined diagnosis of multisomatoform disorder (MS...

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Single Dose Pharmacokinetic (PK) Study Of Paroxetine CR(12.5-37.5mg) In Healthy Chinese Subjects

The study was designed to describe the relationship between dose and pharmacokinetic parameters of paroxetine over the range of proposed dosage strengths of the paroxetine CR tablet (12.5...

Medical and Biotech [MESH] Definitions

Paroxetine

A serotonin uptake inhibitor that is effective in the treatment of depression.

It has todays date...???

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Altostrata   
Altostrata

You'll have to ask the authors of the paper, btdt.

 

Please do not copy big chunks of off-topic information and post them here. It makes the topics tedious to read.

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SouthernFreeze   
SouthernFreeze

finally a bit of progress , ill probably be dead by the time it gets recognized by any psychiatrist or doctor here though 

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btdt   
btdt

You'll have to ask the authors of the paper, btdt.

 

Please do not copy big chunks of off-topic information and post them here. It makes the topics tedious to read.

If you tell me how to do that I will.

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Altostrata   
Altostrata

Don't copy such big chunks!!!!!!!!! Your copy method captured a lot of irrelevant material -- what do those associated articles from Pubmed have to do with this topic?

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btdt   
btdt

 

You'll have to ask the authors of the paper, btdt.

 

Please do not copy big chunks of off-topic information and post them here. It makes the topics tedious to read.

If you tell me how to do that I will.

 

I was addressing this - "You'll have to ask the authors of the paper, btdt." 

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btdt   
btdt

Don't copy such big chunks!!!!!!!!! Your copy method captured a lot of irrelevant material -- what do those associated articles from Pubmed have to do with this topic?

All the other links were about antidepressants too.. I thought somebody may find them interesting as I did.

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Altostrata   
Altostrata

Please don't do that. It makes these topics difficult to read and it's off-topic besides.

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bolletje   
bolletje

 

Hi,

 

I just contacted Drs Harder (the pharmacist from Bavel); he told me he 'd probably have taperingstrips for Venlafaxine in about 3 months from now as well...

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btdt   
btdt

Hi,

 

I just contacted Drs Harder (the pharmacist from Bavel); he told me he 'd probably have taperingstrips for Venlafaxine in about 3 months from now as well...

Wonderful news!!

Please let us know when you can finally buy them.  I sure hope it works. 

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Altostrata   
Altostrata

bolletje, did you speak to any of the Netherlands doctors? Are any helping you with tapering?

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bolletje   
bolletje

I talked to this dr Harder from Bavel; he told me it would take probably another 3 months before he could come up with usable tapering strips; he said normal pharmacy industries would take years on trying to get some reliable results and thus proof that something would actually work, he said I would have to be a little more patient and that he would have results sooner than that ,so in 3 months...

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Altostrata   
Altostrata

Oh, I meant, did you speak with any of the psychiatrists?

 

I think the tapering packets would be of great benefit, but they still will not contain the very gradual dosage ranges some people will need. Still, they're a start and it's good to see so many doctors agreeing tapering can be a problem.

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btdt   
btdt

I would think they would talk to people who have been able to taper and keep a life but perhaps not and that would be a huge disappointment.. in so many ways when people fail because the system it not right... still having small stable amounts may come in handy people are quite creative when it comes to getting the right dose of drug they need.  Guess we will wait and see what happens. Doing a range gradually smaller doses would have made more sense.... but we get what they gives us don't we... and them make the best of it.  Maybe it will have a place maybe not.. hate to see people fail trying and give up on taper tho that would suck

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mammaP   
mammaP

It would be good if people could get 30 of the strips, then they could take the first dose of every strip. That would take 30 days, then the second dose of every strip, another 30 days and so on. This would take 28/30 months? for 20mg and a much safer taper. I wonder if any doctor would agree to that, or even if they would be able to prescribe that way! 

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btdt   
btdt

It would be good if people could get 30 of the strips, then they could take the first dose of every strip. That would take 30 days, then the second dose of every strip, another 30 days and so on. This would take 28/30 months? for 20mg and a much safer taper. I wonder if any doctor would agree to that, or even if they would be able to prescribe that way! 

 

What a great idea!  

I think doctors can do as they please when it comes to how they prescribe most drugs at least here in Canada.  I have had pharmacies give me enough ppi for a year on one script. 

The only time I could see this being a problem is if there had been an over dose previously of an snri or other drug.  In that case the doc gives the pills out a wk at a time so there are not enough drugs on had to overdose with. 

Seems the best way to get beyond this problem is to have the companies making the strips understand the tapering protocol and why it needs to be the way it is.  Since nobody asked us I guess they don't want our input but by talking more to our doctors and explaining why it needs to be the way it is we could maybe shave years off the development process so they can get it right faster. The questionable side of this comes from doctors not taking psych patients seriously when we are able to explain our needs they often still believe we don't understand our own issues as well as they do.  

That is what makes sites like this a good resource with support and understanding maybe more people will be able to identify their issues when they see others here with the same problems.  With the right information perhaps they will be able confidently persuade a doctor to help them do a slow slow taper. 

Peace Mamma and good plan. 

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Altostrata   
Altostrata

Update from this Netherlands organization:

 

Tapering strips to make stopping with diazepam easier

Diazepam tapering strips are a new pharmacotherapeutic tool to make stopping with or dose-reduction of diazepam easier and safer. Gradual dose reduction gives patients time to adjust to the gradually decreasing doses and prevents withdrawal symptoms. Tapering strips allow patients to choose themselves how slow they wish to taper, which will enhance patient commitment and compliance. Taperingstrips are prescription medicines and do not replace standard treatment.

Realization of tapering strips is an initiative of Cinderella Therapeutics. Cinderella does not make the strips themselves and has no commercial interest in providing the strips. Pharmacist drs Paul Harder has been found willing to do this.

Cinderella Therapeutics is a not-for-profit foundation that attempts to make neglected medical drugs and treatments available to patients.

*More detailed info on http://www.cinderella-tx.org

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Toulouse   
Toulouse

did they ever make these strips available in the US? I'd have imagined my doctor or pharmacist would have mentioned it to me as they both know I'm tapering off Paxil.  This would have made things much easier for those who want to get off.

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Altostrata   
Altostrata

You'll have to write the company to find out where they're available.

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primekittycat   
primekittycat

did they ever make these strips available in the US? I'd have imagined my doctor or pharmacist would have mentioned it to me as they both know I'm tapering off Paxil. This would have made things much easier for those who want to get off.

Toulouse, let me know if you plan on writing. If not, I will as this would be very useful for my effexor xr taper.

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scallywag   
scallywag

This is a cross-post about taper kits in the Netherlands. In Feb. 2017, Airwave, a new member from The Netherlands, posted a photo of the taper options available for venlafaxine (Effexor):


... I've recently moved houses so most information is scattered around the place, but i'll try my best to find some of the documents.

At the very least, here is a screenshot of the options i had available for tapering(The one checked here is the one i actually used):

w6lha02d6rlu4ui6g.jpg

some quick translation:
dag = day,
dagen = days,
duur afbouw traject = duration of total tapering program in days.


Link to Airwave's Intro topic

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